MEDICARE: MELINDA NICOLE MANGAN LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	93999	CA

General Provider Information

NPI Number	:	1083394951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELINDA NICOLE MANGAN LMT

Provider Business Mailing Address
First Line	:	1319 SEAL WAY APT D
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6565
Country	:	US
Telephone Number	:	562-762-9223
Fax Number	:

Provider Business Practice Location Address
First Line	:	244 MAIN ST
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6318
Country	:	US
Telephone Number	:	562-596-1898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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